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Ultrasound in Obstetrics & Gynecology :... May 2008Defecation proctography is the standard method used in the investigation of obstructed defecation. Translabial ultrasound has recently been shown to demonstrate... (Comparative Study)
Comparative Study
OBJECTIVES
Defecation proctography is the standard method used in the investigation of obstructed defecation. Translabial ultrasound has recently been shown to demonstrate rectocele, enterocele and rectal intussusception. We performed a comparative clinical study to determine agreement between the two methods.
METHODS
Thirty-seven women scheduled to undergo defecation proctography for obstructed defecation were recruited. Using both proctography and translabial ultrasound, we determined the anorectal angle, presence of a rectocele and rectocele depth, rectal intussusception and prolapse. Measurements were obtained by operators blinded to all other data. All patients rated discomfort on a scale of 0-10.
RESULTS
Six women did not attend defecation proctography, leaving 31 cases for comparison. The mean age was 53 years. Patients rated discomfort at a median of 1 (range 0-10) for ultrasound and 7 (range 0-10) for defecation proctography (P < 0.001). Defecation proctography suggested rectocele and rectal intussusception/prolapse more frequently than did ultrasound. While the positive predictive value of ultrasound (considering defecation proctography to be the definitive test) was 0.82 for rectocele and 0.88 for intussusception/prolapse, negative predictive values were only 0.43 and 0.27, respectively. Cohen's kappa values were 0.26 and 0.09, respectively. There was poor agreement between ultrasound and defecation proctography measurements of anorectal angle and rectocele depth.
CONCLUSIONS
Translabial ultrasound can be used in the initial investigation of defecatory disorders. It is better tolerated than defecation proctography and also yields information on the lower urinary tract, pelvic organ prolapse and levator ani. Agreement between ultrasound and defecation proctography in the measurement of quantitative parameters was poor, but when intussusception or rectocele was diagnosed on ultrasound these results were highly predictive of findings on defecation proctography.
Topics: Adult; Aged; Aged, 80 and over; Anal Canal; Constipation; Defecation; Defecography; Female; Humans; Intussusception; Middle Aged; Predictive Value of Tests; Ultrasonography
PubMed: 18409183
DOI: 10.1002/uog.5337 -
Cleveland Clinic Journal of Medicine Jan 1999When a patient reports constipation, a careful history and physical examination may identify the underlying cause. In many patients, though, no underlying cause is... (Review)
Review
When a patient reports constipation, a careful history and physical examination may identify the underlying cause. In many patients, though, no underlying cause is identified. Empiric treatment with exercise, hydration, fiber supplementation, and mild laxatives is often effective. If constipation does not resolve with these measures, then the physician may refer the patient for further testing for slow colonic transit, pelvic floor dysfunction, or anatomical defects, and in difficult and recalcitrant cases for surgical treatment.
Topics: Biofeedback, Psychology; Calcium; Cathartics; Colectomy; Colon; Constipation; Fecal Incontinence; Female; Gastrointestinal Motility; Humans; Inflammatory Bowel Diseases; Male; Megacolon; Occult Blood; Physical Examination; Radiography; Rectal Prolapse; Rectocele; Thyroid Function Tests
PubMed: 9926630
DOI: 10.3949/ccjm.66.1.41 -
Annals of Medicine and Surgery (2012) Jul 2022Anorectal functional disorder encompasses arrays of conditions including Obstructive Defecation Syndrome (ODS) and Fecal Incontinence (FI). Biofeedback Therapy (BFT)...
BACKGROUND
Anorectal functional disorder encompasses arrays of conditions including Obstructive Defecation Syndrome (ODS) and Fecal Incontinence (FI). Biofeedback Therapy (BFT) serves as first line therapy to re-train pelvic floor coordination, rectal sensation and strengthening pelvic floor muscle. The aim of this study is determining the efficacy of BFT in our centre.
METHODS
This is a retrospective observational cohort study of patients attended biofeedback therapy session from January 2013 to December 2018. Descriptive statistic was used to analyse the data.
RESULT
Total 99 patients with mean age of 44.6 ± 18.1 with female 56% (n = 55) and male 44% (n = 44) attended BFT session. Overall, 77 had CC (77%) and 23 (23%) had FI. Mean number of sessions was 11.8. Overall improvement rate 42 (42%), no improvement 32 (32%) and defaulted 26 (26%). In patients with CC, 32 (41.6%) had improvement in symptoms, 23 (29.9%) had no improvements, 22 (28.6%) defaulted BFT.Patients with FI, 7 (30.4%) had Obstetric Sphincter Injury, 7 (30.4%) had traumatic anal injury, 3 (13.0%) has Low Anterior Resection Syndrome, 2 (8.7%) had sphincter injury following anal sepsis, 2 (13.0%) had rectocele repair and 1 (4.3%) were idiopathic. 9 patients (39.1%) had stoma created. Overall response rate was: 10 patients (43.5%) had improvement in symptoms, 9 patients (39.1%) had no improvement, 4 patients (17.4%) defaulted therapy.
CONCLUSION
Our outcome rate is lower compared to published due the limited access and logistic restrictions. This issue should be given great consideration such as broadening the service and training.
PubMed: 35860081
DOI: 10.1016/j.amsu.2022.103848 -
Annals of Coloproctology Aug 2021External rectal prolapse (ERP) is frequently associated with other pelvic disorders, such as enterocele, rectocele, and perineal descent. Evacuation proctography makes...
PURPOSE
External rectal prolapse (ERP) is frequently associated with other pelvic disorders, such as enterocele, rectocele, and perineal descent. Evacuation proctography makes it possible to visualize the development of such anatomical abnormalities. The aim of this study was to identify the variables that would predict associated abnormalities in patients with ERP.
METHODS
Between February 2010 and August 2019, 124 female patients with ERP, who were evaluated using proctography were included in this study. Enterocele was diagnosed when the extension of the loop of the small bowel was located between the vagina and rectum. A significant rectocele was defined as >20 mm in diameter. Multivariate analysis was used to establish which morphological parameters best predicted the presence of enterocele or rectocele.
RESULTS
Sixty-five patients had ERP alone, while 59 patients (47.6%) had additional findings on proctography. The most frequently associated abnormality was enterocele with 48 of the patients (38.7%) having this condition. Rectocele was detected in 17 of the 124 patients (13.7%). The median length of the ERP was 30 mm (range, 7 to 147 mm). The results of the stepwise multiple regression analysis showed that a history of hysterectomy and the length of the ERP were significantly associated with the presence of enterocele. The analysis showed that the longer the prolapse, the higher the incidence of enterocele. A history of hysterectomy was also significantly associated with the presence of rectocele.
CONCLUSION
Patients with ERP often have associated anatomical abnormalities and should be investigated thoroughly before planning surgical treatment.
PubMed: 33445838
DOI: 10.3393/ac.2020.07.16 -
The Korean Journal of Gastroenterology... Jul 2017Chronic constipation is a common gastrointestinal disorder diagnosed using Rome III criteria. Defecography is a radiographic method used to identify anatomic...
BACKGROUND/AIMS
Chronic constipation is a common gastrointestinal disorder diagnosed using Rome III criteria. Defecography is a radiographic method used to identify anatomic abnormalities of anorectum. The present study aimed to evaluate the defecographic findings in patients with severe idiopathic chronic constipation.
METHODS
One hundred patients, who complained of severe idiopathic chronic constipation with abnormal balloon expulsion test, underwent defecography after injection of barium. An analysis of radiographs was performed by an expert radiologist for the diagnosis of descending perineum syndrome, rectocele, enterocele, rectal ulcer, rectal prolapse, fecal residue of post defecation, and etc. Then, they were compared between the two sexes.
RESULTS
Normal defecography was only observed in two participants. Descending perineum syndrome was the most common abnormality (73.3%). The results showed that rectocele (80.8%) and descending perineum syndrome (69.2%) were most frequent in women. In males, descending perineum syndrome and rectal prolapse were more prevalent (87% and 43.5%, respectively). Compared with men, rectocele and rectal ulcer were more frequently observed in women (p<0.001, and p=0.04, respectively), while men were more affected by descending perineum syndrome (p=0.04). In total, women had a greater incidence of abnormal defecographic findings compared with men (p=0.02).
CONCLUSIONS
Defecography can be performed to detect anatomic abnormalities in patients with severe idiopathic chronic constipation and abnormal balloon expulsion test. This technique can assist physicians in making the most suitable decision for surgical procedure.
Topics: Adult; Chronic Disease; Constipation; Defecography; Female; Humans; Male; Middle Aged; Rectal Diseases; Rectocele; Retrospective Studies; Sex Factors
PubMed: 28728315
DOI: 10.4166/kjg.2017.70.1.39 -
Outcomes of a modified Bresler procedure for the treatment of rectocele with rectal intussusception.Gastroenterology Report Dec 2020Obstructed defecation syndrome (ODS) is a condition that is frequently caused by rectocele and rectal intussusception. This study aimed to evaluate the effectiveness of...
BACKGROUND
Obstructed defecation syndrome (ODS) is a condition that is frequently caused by rectocele and rectal intussusception. This study aimed to evaluate the effectiveness of a modified Bresler procedure for the treatment of ODS. The outcomes of this modified procedure were compared with the stapled transanal rectal resection (STARR) procedure.
METHODS
We performed a retrospective analysis of the clinical data from 76 female patients who presented with ODS between June 2014 and June 2016. The patients were divided into two treatment groups, namely Modified and STARR. Patients in the Modified group (=36) underwent the modified Bresler procedure, which involved posterior rectal-wall resection using a circular tubular stapler with multilevel purse-string sutures. Patients in the STARR group (=40) underwent the standard STARR procedure. We analysed post-operative complications, Wexner constipation scores (WCS), rectocele depths, and four-point post-operative satisfaction scales.
RESULTS
Patients in the Modified group exhibited shorter operative times and fewer post-operative complications (both <0.05). At 12 months post-operatively, both the Modified and STARR groups displayed a significant improvement in the Wexner constipation score and the depth of rectocele. The post-operative WCS for the Modified group were significantly improved compared to those for the STARR group (<0.05), while there was no significant difference in the rectocele depth between the two groups (>0.05). Post-operative interviews at post-operative 12 months showed that patients in the Modified group had a better satisfaction (=0.05).
CONCLUSIONS
Our modified procedure may be an effective treatment strategy for patients experiencing ODS caused by rectocele and rectal intussusception, with fewer complications and effective relief of symptoms.
PubMed: 33442479
DOI: 10.1093/gastro/goaa027 -
GMS Interdisciplinary Plastic and... 2013The objective of the study is to examine the efficacy of the purely laparoscopic reconstructive management of cystocele and rectocele with mesh, to avoid the risk of...
INTRODUCTION
The objective of the study is to examine the efficacy of the purely laparoscopic reconstructive management of cystocele and rectocele with mesh, to avoid the risk of erosion by the graft material, a well known complication in vaginal mesh surgery.
MATERIAL AND METHODS
We performed a prospective, single-case, non-randomized study in 325 patients who received laparoscopic reconstructive management of pelvic organe prolaps with mesh. The study was conducted between January 2004 and December 2012 in a private clinic in India. The most common prolapse symptoms were reducible vaginal lump, urinary stress incontinence, constipation and flatus incontinence, sexual dysfunction and dypareunia. The degree e of the prolaps was staged according to POPQ system. The approach was purely laparoscopic and involved the use of polypropylene (Prolene) or polyurethane with activated regenerated cellulose coating (Parietex) mesh.
RESULTS
The mean age was 55 (30-80) years and the most of the patients were multiparous (272/325). The patients received a plastic correction of the rectocele only (138 cases), a cystocele and rectocele (187 cases) with mesh. 132 patients had a concomitant total hysterectomy; in 2 cases a laparoscopic supracervical hysterectomy was performed and 190 patients had a laparoscopic colposuspension. The mean operation time was 82.2 (60-210) minutes. The mean follow up was 3.4 (3-5) years. Urinary retention developed in 1 case, which required a new laparoscopical intervention. Bladder injury, observed in the same case was in one session closed with absorbable suture. There were four recurrences of the rectocele, receiving a posterior vaginal colporrhaphy. Erosions of the mesh were not reported or documented.
CONCLUSION
The pure laparoscopic reconstructive management of the cystocele and rectocele with mesh seems to be a safe and effective surgical procedure potentially avoiding the risk of mesh erosions.
PubMed: 26504702
DOI: 10.3205/iprs000031 -
Ultrasound in Obstetrics & Gynecology :... Oct 2006
Review
Topics: Cystocele; Female; Humans; Pelvic Floor; Rectocele; Ultrasonography; Uterine Prolapse
PubMed: 17001745
DOI: 10.1002/uog.3828 -
Il Giornale Di Chirurgia 2013Rectocele is defined as a herniation of the rectal wall inside the vagina due to a defect of the recto-vaginal septum. It is traditionally considered a posterior... (Comparative Study)
Comparative Study
Rectocele is defined as a herniation of the rectal wall inside the vagina due to a defect of the recto-vaginal septum. It is traditionally considered a posterior compartment damage with weakness of posterior vaginal wall support resulting in a bulging of the rectum into the vaginal cavity. One of the main causes of rectal prolapse is the operative vaginal birth, although the evidence of the defect may occur after many years The treatment of rectocele is surgical, and the approach can be transperineal, transvaginal, and transanal or, in selected cases, transperitoneal through open or laparoscopic techniques. In this study we compare two transvaginal surgical techniques - i.e. the perineal body anchorage to the posterior septum and the traditional Denonvilliers' transversal suture after removing of the vaginal skin, with the mostly performed transanal procedure, the STARR - comparing the data from the literature on their results. Mean hospital stay, rectal symptoms, dyspareunia, quality of life, recurrence rate and postoperative complications have been considered. Both transvaginal and transrectal surgical techniques are effective to solve posterior compartment defect and to improve the quality of life. Vaginal approach may interfere with the sexual activity; furthermore it is associated with minimal postoperative pain than the transanal approach. Better anatomic results are assured after endovaginal surgery, while better rectal function prevail after the transanal approach. Vaginal techniques are more suitable to gynecologists, whereas the transrectal ones are usually performed by colo-proctologists or general surgeons.
Topics: Anal Canal; Female; Humans; Rectocele; Vagina
PubMed: 24342163
DOI: No ID Found -
World Journal of Gastroenterology Mar 2019Obstructed defecation syndrome (ODS) is a widespread disease in the world. Rectocele is the most common cause of ODS in females. Multiple procedures have been performed... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Obstructed defecation syndrome (ODS) is a widespread disease in the world. Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection (STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.
AIM
To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.
METHODS
A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients (group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients (group B) underwent the STARR procedure. Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.
RESULTS
In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min (group A) 39.24 ± 6.53 min (group B). Mean hospital stay was 3.15 ± 0.70 d (group A) 3.14 ± 0.54 d (group B). Mean blood loss was 10.91 ± 2.52 mL (group A) 10.14 ± 1.86 mL (group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was 17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm (group A) 4.18 ± 0.95 cm (group B) preoperatively to 1.19 ± 0.43 cm (group A) 1.54 ± 0.82 cm (group B) one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients' (30/34, 88.2%) final outcomes were judged as effective and 4 (4/34, 11.8%) as moderate in group A, whereas in group B, 30 (30/37, 81.1%) patients' outcomes were judged as effective, 5 (5/37, 13.5%) as moderate, and 2 (2/37, 5.4%) as poor.
CONCLUSION
Khubchandani's procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.
Topics: Adult; Aged; Blood Loss, Surgical; Defecography; Digestive System Surgical Procedures; Female; Humans; Intestinal Obstruction; Length of Stay; Male; Middle Aged; Operative Time; Postoperative Complications; Rectocele; Rectum; Surgical Stapling; Treatment Outcome; Young Adult
PubMed: 30918434
DOI: 10.3748/wjg.v25.i11.1421